Benzodiazepines are a class of prescription medication dispensed to treat insomnia, seizure disorders, panic and anxiety disorders, and muscle tension on a short-term basis. These medications are sedative-hypnotics, which means they act on levels of GABA (gamma-Aminobutyric acid) in the brain. GABA is a neurotransmitter that helps to keep a person calm and mitigates the stress response.
Benzos, as they are often referred to, act as central nervous system depressant medications, slowing down bodily functions like respiration, blood pressure, and heart rate while reducing anxiety, agitation, tremors, muscle tension, and lowering body temperature. In general, they are considered to be relatively safe when taken as directed, under the supervision of a medical professional, for the short-term management of specific symptoms.
Common benzodiazepines include Restoril (temazepam), Klonopin (clonazepam), Ativan (lorazepam), Xanax (diazepam), and Valium (alprazolam). Benzodiazepines are not meant to be combined with other central nervous system depressants, such as alcohol, because these substances act in a similar fashion on the brain and body. This means that mixing alcohol with a benzodiazepine can increase the effects of both substances and elevate the potential risk factors and possible side effects.
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Mixing benzodiazepines with other drugs can have disastrous effects. For instance, combining benzos with stimulants, such as cocaine, methamphetamine or prescription ADHD medications, can have a kind of push-and-pull effect that can be difficult to predict. The combination can more quickly lead to overdose, as each drug can mask the effects of the other. Mixing benzos with other depressants, such as opioids or alcohol, compounds the possible risks of each substance as well.
Since benzodiazepines and alcohol are both depressants, their interaction can worsen the effects of each substance. This combination can lead to the following possible interactions and hazards:
Both benzos and alcohol act on the brain in similarly, which can lead to increased intoxication faster. It may take much less of either substance to feel drunk or high than when taken individually. The combination of alcohol and benzodiazepines may enhance the euphoric effects of each, and the behavioral, psychological, and physical ramifications of each are also heightened.
It can be harder to regulate dosage when mixing these substances, and an overdose can occur in much smaller amounts of each than is normally tolerated. The U.S. Centers for Disease Control and Prevention (CDC) publishes the Drug Abuse Warning Network (DAWN) results from 2010 that show that alcohol was involved in 27.2 percent of all benzodiazepine-related emergency department (ED) visits that year and in 21.4 percent of all benzodiazepine overdose deaths.
The journal Patient Care explains that benzo overdoses are rarely fatal on their own. When they are lethal, it is typically related to the combination of the benzo with another substance, most frequently alcohol. The National Institute on Drug Abuse (NIDA) publishes that in 2016, more than 10,000 people in the United States died from a benzo overdose.
An overdose involving benzos and alcohol can include many symptoms, such as impaired coordination and reflexes, slow and weak pulse and blood pressure, breathing issues, nausea and vomiting, extreme mental confusion, drowsiness and a possible loss of consciousness, cold and clammy skin that may appear blue in color, blurred or double vision, and possible coma. An overdose is an immediate medical emergency.
Benzodiazepines and alcohol are both addictive substances that you can build up a tolerance to and physical dependence on with regular use. When using the substances together, tolerance can be reached more quickly, and it can then take more of each substance for the desired effects to occur.
Physical dependence can manifest much more quickly, too, which can include difficult, and even potentially life-threatening, withdrawal symptoms when the substances wear off and are not active in the bloodstream. Extreme physical dependence can raise the odds for battling addiction, as it can more quickly lead to an inability to control drug use as a result of intense cravings and adverse withdrawal symptoms when not taking the drugs.
The long-term combination of alcohol and benzos can cause damage to internal organs, including the liver, heart, and lungs. Drinking too much on a regular basis can lead to alcohol-related liver disease (ARLD), the National Health Service (NHS) warns, and combining alcohol with a benzo can exacerbate this risk.
Damage to the brain from prolonged benzodiazepine use is also documented, Psychology Today reports, and this can also be compounded by mixing benzos with alcohol. The heart and lungs are taxed through the combination of alcohol and benzos. With long-term and perpetuated use, damage to both the cardiovascular and respiratory system may occur.
In short, there is no acceptable amount of alcohol that can be consumed while taking benzodiazepines. The U.S. Drug Enforcement Administration (DEA) publishes that as of 2011, more than 20 million Americans had misused a benzodiazepine drug at some point in their lives.
If a benzo is taken other than as prescribed, it carries significant risks, and mixing it with alcohol can compound all of the potential adverse consequences that can occur. Benzodiazepines are meant to be taken to calm overactive nerve firings.
If you don’t have a medical need for this, the drug can dangerously depress the central nervous system. Adding in alcohol only increases the hazards. Short-acting benzos, such as Xanax, may be even more dangerous to mix with alcohol than long-acting ones, as they can increase the risk for a toxic overdose more rapidly.
That being said, a benzo with a longer duration of action, like Restoril, can also be hazardous, as it may be unclear how much the drug is actually affecting you, and adding in alcohol can be deadly.
It can be difficult to determine exactly how the combination of a benzo and alcohol will affect you; therefore, it is considered safest just to avoid mixing the two. The prescribing information for Xanax warns that mental impairment and central nervous system depression are heightened when combining alcohol with the medication and, therefore, should be cautioned against. Again, it is not considered safe to combine benzodiazepines with alcohol, as the results can be too unpredictable.
(October 2014). Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse-Related Emergency Department Visits and Drug-Related Deaths. Centers for Disease Control and Prevention. Retrieved December 2018 from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a1.htm
(November 2014). Alcohol: The Forgotten Factor in Prescription Drug Overdoses. Patient Care. Retrieved December 2018 from http://www.patientcareonline.com/addiction/alcohol-forgotten-factor-prescription-drug-overdoses
(August 2018). Overdose Death Rates. National Institute on Drug Abuse. Retrieved December 2018 from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
(October 2018). Overview Alcohol-Related Liver Disease. NHS. Retrieved December 2018 from from https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/
(November 2010). Brain Damage from Benzodiazepines: The Troubling Facts, Risks, and History of Minor Tranquilizers. Psychology Today. Retrieved December 2018 from https://www.psychologytoday.com/us/blog/side-effects/201011/brain-damage-benzodiazepines-the-troubling-facts-risks-and-history-minor
(January 2013). Benzodiazepines. Drug Enforcement Administration. Retrieved December 2018 from https://www.deadiversion.usdoj.gov/drug_chem_info/benzo.pdf
(September 2016). Xanax. Pfizer. Retrieved December 2018 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdf